Alcohol-Attributable Deaths and Years of Potential Life Lost—United States, 2001

Alcohol-Attributable Deaths and Years of Potential Life Lost—United
States, 2001

MMWR. 2004;53:866-870

1 table omitted

Excessive alcohol consumption is the third leading preventable cause
of death in the United States1 and is associated with multiple
adverse health consequences, including liver cirrhosis, various cancers, unintentional
injuries, and violence. To analyze alcohol-related health impacts, CDC estimated
the number of alcohol-attributable deaths (AADs) and years of potential life
lost (YPLLs) in the United States during 2001. This report summarizes the
results of that analysis, which indicated that approximately 75,766 AADs and
2.3 million YPLLs, or approximately 30 years of life lost on average per AAD,
were attributable to excessive alcohol use in 2001. These results emphasize
the importance of adopting effective strategies* to reduce excessive drinking,
including increasing alcohol excise taxes and screening for alcohol misuse
in clinical settings.

Alcohol-Related Disease Impact (ARDI)* software was used to estimate
the number of AADs and YPLLs. ARDI estimates AADs by multiplying the number
of deaths from a particular alcohol-related condition by its alcohol-attributable
fraction (AAF).Certain conditions (e.g., alcoholic cirrhosis of the liver)
are, by definition, 100% alcohol attributable. For the majority of the chronic
conditions profiled in ARDI, the system calculates AAFs by using relative
risk estimates from meta-analyses2,3 and prevalence data on alcohol
use from the Behavioral Risk Factor Surveillance System. For some conditions,
especially those with an acute onset (e.g., injuries), ARDI includes direct
estimates of AAFs. Direct estimates of AAFs are based on studies assessing
the proportion of deaths from a particular condition that occurred at or above
a specified blood alcohol concentration (BAC).4,5 For acute conditions,
a death is alcohol attributable if the decedent (or, as in the case of motor-vehicle
traffic, a driver or non-occupant) had a BAC of ≥0.10 g/dL. AAFs for motor-vehicle–traffic
deaths are obtained from the Fatality Analysis Reporting System.6 YPLLs,
a commonly used measure of premature death, are then calculated by multiplying
age- and sex-specific AAD estimates by the corresponding estimate of life
expectancy. For chronic conditions, AADs and YPLLs were calculated for decedents
aged ≥20 years; for the majority of acute conditions, they were calculated
for decedents aged ≥15 years. However, ARDI also provides estimates of
AADs and YPLLs for persons aged <15 years who died from motor-vehicle crashes,
child maltreatment, or low birthweight. Consistent with World Health Organization
recommendations,7 the harmful and beneficial effects of alcohol
use are reported separately.

In 2001, an estimated 75,766 AADs and 2.3 million YPLLs were attributable
to the harmful effects of excessivealcohol use (Table). Of the 75,766 deaths,
34,833 (46%) resulted from chronic conditions, and 40,933 (54%) resulted from
acute conditions. Overall, 54,847 (72%) of all AADs involved males, and 4,554
(6%) involved persons aged <21 years. Of the deaths among males, 41,202
(75%) involved men aged ≥35 years; of those deaths, 41,202 (58%) were attributed
to chronic conditions. For males and females combined, the leading chronic
cause of AADs was alcoholic liver disease (12,201), and the leading acute
cause of AADs was injury from motor-vehicle crashes (13,674). In addition,
in 2001, an estimated 11 lives were saved because of the potential benefits
of excessive alcohol use, all of which were attributable to a reduced risk
for death from cholelithiasis (i.e., gall bladder disease).

Of the estimated 2,279,322 YPLLs, 788,005 (35%) resulted from chronic
conditions, and 1,491,317 (65%) resulted from acute conditions (Table). Overall,
1,679,414 (74%) of the total YPLLs were among males, and 271,392 (12%) involved
persons aged <21 years. Of all YPLLs among males, 973,214 (58%) involved
men aged >35 years, of which 53% were attributed to chronic conditions. Deaths
from alcoholic liver disease resulted in 316,321 YPLLs, and deaths from motor-vehicle–traffic
crashes resulted in 579,501 YPLLs.

In 2001, excessive alcohol use was responsible for approximately 75,000
preventable deaths and 2.3 million YPLLs in the United States. The majority
of these deaths involved males (72%), and the majority of the deaths among
males involved those aged ≥35 years (75%). Approximately half of the total
deaths and two thirds of the total YPLLs resulted from acute conditions. Moreover,
the BAC level used in this analysis for defining an alcohol-attributable injury
death (≥0.10 g/dL) is higher than the BAC level used by the National Institute
for Alcohol Abuse and Alcoholism8 to define binge drinking (≥0.08
g/dL); as a result, all of the injury deaths were attributable to binge alcohol
use (i.e., ≥5 drinks per occasion for men: ≥4 drinks per occasion for
women).

The findings described in this report are similar to recent estimates
of AADs attributable to excessive drinking in the United States.1 In
contrast, earlier estimates of alcohol-related deaths9 were higher
than the estimates in this analysis and other recent estimates1 because
they were calculated by using a different methodology and were based on mortality
from all levels of alcohol consumption, not just excessive drinking.

The 2.3 million YPLLs for excessive drinking is approximately half of
the total YPLLs that were caused by smoking in 1999, the most recent year
for which this estimate is available,10 even though mortality attributable
to tobacco use is nearly six times higher than that attributable to excessive
drinking. This difference exists because many AADs, particularly those caused
by injuries, primarily affect youth and young adults, and deaths attributable
to tobacco use are uncommon in this population.

The findings in this report are subject to at least six limitations.
First, data on alcohol use, which are used to calculate indirect estimates
of AAFs, are based on self-reports and might underestimate the true prevalence
of excessive alcohol use because of underreporting of alcohol use by survey
respondents and sampling noncoverage. Second, the risk estimates used in ARDI
were calculated by using average daily alcohol consumption levels that begin
at levels greater than those typically used to define excessive drinking in
the United States. Third, deaths among former drinkers, who might have discontinued
their drinking because of alcohol-related health problems, are not included
in the calculation of AAFs, even though some of these deaths might have been
alcohol attributable. Fourth, ARDI does not include estimates of AADs for
several conditions (e.g., tuberculosis, pneumonia, and hepatitis C) for which
alcohol is believed to be an important risk factor but for which suitable
pooled risk estimates were not available. Fifth, ARDI exclusively uses the
underlying cause of death from vital statistics to identify alcohol-related
conditions and does not consider contributing causes of death that might be
alcohol related. Finally, age-specific estimates of AAFs were only available
for motor-vehicle–traffic deaths, even though alcohol involvement varies
by age, particularly for acute conditions.

This analysis illustrates the magnitude of the health consequences of
excessive alcohol use in the United States. In addition to estimating the
national health effects of alcohol use, ARDI software also can produce state
estimates of AADs and YPLLs. Such state-specific analyses are needed because
the prevalence of excessive alcohol use, particularly binge drinking, is known
to vary substantially by location. State-specific results also can focus discussions
of effective public health strategies (e.g., increasing alcohol excise taxes
and screening for alcohol misuse in clinical settings) to prevent excessive
alcohol use and its adverse health and social consequences.

Acknowledgment

Funding for the development of ARDI software was provided by the Robert
Wood Johnson Foundation, Princeton, New Jersey.